“In the Netherlands 5.6% of all emergency hospitalizations are medication related. More than half of these admissions (19,000) are preventable.” According to the study “Early recognition of medication related problems in the elderly” by Carolien Sino, medication problems can be detected in an early stage and even be prevented with a standard observation checklist. Even more registration work for the care professional? Vitaphone believes that this registration should be less for the professional and can become more for the patient. Provide the patient with the correct tools so he or she can stay healthy.

We agree that the process in getting your medication in the Netherlands is very good, until it reaches the patient. After the medication reached the patients front door there is no support anymore. When the medication reached the patient he or she (or the care professional) is responsible for the medication intake. We are convinced that the patient needs more support at home. If the patient just takes the medication: no worries. But if this is not the case, the patient needs to get support. We trust the PICO in this; our medication adherence support system. The PICO supports the patient when the medication is not taken. In this way the patient can self regulate their medication and get the support from the care professional if needed.

In a comprehensive publication in US Pharmacist, the Director of US Pharmacy’s Clinical Services, Mr. Meece, concludes that pharmacist-based assessment and monitoring can result in improved adherence to medication; in this case to insulin therapy. Mr. Meece found studies that report positive effect of pharmacist interventions on treatment outcomes and adherence. Medication therapy management (MTM) is a service designed to improve collaboration among pharmacists, physicians and other healthcare professionals and enhance communication between patients and their healthcare team. Another tool is motivational interviewing (MI): a method for interacting with patients.

Although the results are (very) positive related to adherence, quality of life and healthcare costs (less hospitalizations), the pharmacist’s efforts to get these results are not the average activities in a pharmacy. It’s up to regulators to find the right incentives for pharmacists to use techniques like MTM and MI.

Nevertheless, this article stimulates companies like us to keep on supporting pharmacists with tools so they can further improve patient’s medication adherence!

It’s good to have a clear view of all factors that influence medication adherence! A qualitative review of 102 studies resulted in very comprehensive Infographic. Let us have a further look at the demographic factors:

Age: most of the studies (14) show an increased compliance, some (3) a decreased and some (4) show no effect on compliance at elderly patients. With middle-aged or young patients, all (7) examined studies show a decreased compliance!

Ethnicity

Caucasian: All (4) studies show an increased compliance

Minorities: All (10) examined studies show no effect on compliance

Gender: Most studies (11) show an increased compliance, some (4) a decreased compliance and some(6) show no effect at female patients

Education level: only 2 studies show an decreased adherence, a few more (4) show an increase but the most (6) show no effect

Marital status: five studies show an increased adherence and the same amount of studies show no effect on adherence on married status

Possible conclusion: although medication adherence support systems like to focus on the elderly, this doesn’t seem to be the most important target! It’s much more appropriate to look at other factors.

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Early January is a great moment for our fortune tellers to predict the future of healthcare. Although we are more eager to understand how long the polar winds will continue to blow in North America and spring finally will end in Western Europe, these professionals tell us that we can expect in 2014 of healthcare improvements. Most of the time, the suggestions have a question mark at the end: “Roboman, Arise: Should You Offer Wearable Powered Exoskeleton Rehabilitation for Individuals with Paraplegia? The Pressure Is On: Is Catheter-based Renal Denervation for Treatment-resistant Hypertension a New Cash Cow or More Fuel for the Fire?”1. Well: I don’t have the answers.
Another question from the fortune tellers: “Will Intelligent Pills Magically Improve Medication Adherence and Prevent Readmissions?”1 . The answer is easy: no, they won’t. Because it’s not about ‘Intelligent Pills’ or ‘Prepacked Medication’ alone. It’s about the way you deal with the information. Did the patient take the pills: great news, no action is needed just sometimes a small tap on the shoulder so that the patients also know they are doing great. But if the Medication Adherence Support System registers that the pills haven’t been taken, action is needed. That can be a call, a sms or even a one-on-one meeting with the user. And the presentation of his/her results of the level of adherence. Plus personal attention. Only that way we can improve the 50% medication adherence that we experience today, according to WHO.

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HIN (Healthcare Intelligence Network) has published a report of their benchmark which compares 104 healthcare organizations on how they are improving medication adherence in their populations. Complex patients are the most common targets of medication adherence programs (75 percent of the responds). The use of multi-dose blister packs has more than quadrupled in the last 12 months, from 7 to 29 percent. Hypertension has now replaced diabetes as the condition where healthcare organizations think medication adherence programs have the greatest effect, according to 61% of the respondents.

The figure below shows that most respondents think telephonic follow-up will work to improve Medication Adherence (MA). We, at Vitaphone, think a combination of different tactics is the best approach, with a medication adherence support system as basic tool.

“Multidose drug dispensing(MDD), also known as automated drug dispensing, is a sophisticated dosing aid that provides patients with robot-dispensed unit doses. All drugs intended for one dosing moment are gathered in disposable bags and labelled with patient data, drug contents and the date and time for intake.”1 This looks something like this:

PICO medication roll

“The number of community-dwelling MDD users in The Netherlands increased strongly in recent years till 360.000 in 2011.”1 A clinical study in the Netherlands demonstrated that through multidose drug dispensing, patients older than 65 years of age have a better medication adherence than patients with normally dispensed medication!

So patients who get their medication on a roll adhere 23% better to their medication. And interesting part of this study is that they also measured the knowledge of patients of their medicines. The result was that; “the percentage of patients with adequate knowledge was lower for MDD users (40%) compared with non-MDD users (79%, P < 0.001).”1 Patients using the MMD system know less of the individual medicine in that system, but the adherence is much better. The conclusion is: “Knowledge is only one of the many factors that could influence adherence. Forgetfulness and practical difficulties with medication management (e.g. removing medication from its primary packaging) might be more important barriers to adequate adherence in this specific group of older patients.”1 Within the group of MDD users, the knowledge of MMD drugs was low: “35%”1 while the knowledge of non-MDD drugs was very high “92%”1.

It’s a very nice study that shows that you don’t have to know anything about your medication to be adherent!

[1] Medication adherence and knowledge of older patients with and without multidose drug dispensing, by Henk-Frans Kwint, Glenn Stolk, Adrianne Faber, Jacobijn Gussekloo, Marcel L. Bouvy, published on http://ageing.oxfordjournals.org/ by Oxford University Press on 5 July 2013 in Age and Ageing 2013; 42: pages 620–626

There is an ongoing drug abuse epidemic. Watch the video to get an overview of the problem in Oklahoma, USA.

PDMP, a prescription monitoring program, is one of the most promising resources to help clinicians identify, intervene and curb drug prescription abuse. PDMPs are state-run electronic databases – functioning in 47 U.S. states and territories – that track the prescription and dispense of drugs to patients. Pharmacists report to a PDMP each time a prescription is filled for a controlled substance medication.

When this information is available at the point of care, it can help clinicians to distinguish between patients who legitimately need opioid medications and those who may be seeking to misuse these drugs. While PDMPs can serve as a valuable tool, most clinicians typically don’t use them. This is largely because they have been devious or time consuming to access (especially when outside of a clinician’s normal prescribing workflow).

We see the need to automate this. But what we also see, is the need to support patients that take these medications. Our solution is a real-time monitoring of the intake moments. We think this could be integrated with the health IT systems used by these physicians. Interoperability is essential in this. And last but not least: implement the solution within the physician’s workflow!